Small cell carcinoma of the lung diagnostic study of choice: Difference between revisions

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== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
===Overview===
Chest [[CT scan]], preferably with [[intravenous]] [[contrast]] administration, may be helpful in the [[diagnosis]] of small cell carcinoma. Findings on [[CT scan]] suggestive of small cell carcinoma include [[Hilum|hilar]] mass, [[mediastinal]] involvement, numerous [[lymphadenopathy]], direct infiltration of adjacent structures, [[necrosis]] and [[hemorrhage]]. Small cell carcinoma of the lung is the most common cause of [[SVC obstruction]], due to both compression/[[thrombosis]] and/or direct infiltration 2.  All patients with confirmed diagnosis of SCLC by [[histopathological]] findings should undergo a [[CT scan]] of the [[abdomen]] for staging purposes. [[Computed tomography|CT scan]] of the [[abdomen]] helps identify [[metastasis]] to organs, such as the [[liver]] or the [[adrenal glands]]. Brain imaging is also mandatory for staging; however, brain [[MRI]] is preferred over brain [[CT scan]] due to its superior [[sensitivity]] for the detection of brain [[metastasis]].  In addition, when limited stage small cell lung cancer is suspected, [[PET]] CT scan should be performed.


===== Template statements =====
==CT==
Chest [[Computed tomography|CT scan]], preferably with [[intravenous]] [[contrast]] administration, may be helpful in the [[diagnosis]] of small cell carcinoma. Findings on [[Computed tomography|CT scan]] suggestive of small cell carcinoma include:<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
*[[Hilum|Hilar]] mass
*[[Mediastinum|Mediastinal]] involvement
*Numerous [[lymphadenopathy]]
*Direct infiltration of adjacent structures
*[[Necrosis]]
*[[Hemorrhage]]
*The most common cause of [[SVC obstruction]] is SCLC, because of both compression or [[thrombosis]] and or direct infiltration. 
*[[CT-scans|CT]] is used to stage small cell lung cancer.
*CT scan of the abdomen helps identify [[metastasis]] to organs, such as the [[liver]] or the [[adrenal glands]]. 
*[[Brain]] imaging is also mandatory for staging however a brain [[MRI]] is preferred over brain [[CT scan]] due to its superior [[sensitivity]] for the detection of [[brain]] [[metastasis]]. 
*[[PET]] [[CT-scans|CT]] scan should be performed if limited stage small cell lung cancer is suspected.


=== Study of choice: ===
==Microscopic Pathology==
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The following result of [gold standard test] is confirmatory of [disease name]:
** Result 1
** Result 2
* The [name of the investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of the investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison table for diagnostic studies of choice for [disease name] ====
In small cell lung cancer, the tumor cells are small and round, but they can sometimes be ovoid or spindle shaped.  They have a scant [[cytoplasm]] with a high mitotic count and a hyperchromatic [[nuclei]].  Nearly all small cell lung cancer are immunoreactive for [[keratin]], [[thyroid transcription factor 1]], and epithelial membrane antigen.  Neuroendocrine and neural differentiation result in the expression of molecules like dopa decarboxylase, [[calcitonin]], neuron-specific [[enolase]], [[chromogranin A]], [[CD56]] (also known as nucleosomal histone kinase 1 or neural-cell adhesion molecule), gastrin-releasing peptide, and [[insulin-like growth factor 1]].  One or more markers of neuroendocrine differentiation can be found in approximately 75% of small cell lung cancer.<ref name="NCI">National Cancer Institute: PDQ® Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute.  Available at: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional.</ref>
{|
 
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
|[[Image:Lung small cell carcinoma (1) by core needle biopsy.jpg|300px|thumb| Histopathologic image of small cell carcinoma of the lung. CT-guided core needle biopsy. H & E stain.By No machine-readable author provided. KGH assumed (based on copyright claims),via Wikimedia Commons <ref>href="http://www.gnu.org/copyleft/fdl.html">GFDL<nowiki></a></nowiki> or <nowiki><a href="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0</a></nowiki>], <nowiki><a href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg"></nowiki></ref>]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
|[[Image:Lung small cell cancer 01.jpeg|300px|thumb| Micrograph of a small-cell carcinoma of the lung showing cells with nuclear moulding, minimal amount of cytoplasm and stippled chromatin. FNA specimen. Field stain.By No machine-readable author provided. KGH assumed (based on copyright claims), via Wikimedia Commons <ref>href="http://www.gnu.org/copyleft/fdl.html">GFDL ="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0], href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg"></ref>]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|- [[Image:Lung small cell cancer 03.jpeg|300px|thumb| Anaplastic (microcellular, oat cell) carcinoma from the lung., via Wikimedia Commons <ref>href="https://commons.wikimedia.org/wiki/File:Carcinoma_microcellulare_oatcell_carcinoma_or_anaplastic_carcinoma_(lung)H%26E_magn_200x.jpg</ref>]]
|-
|
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
|
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
|}
<small> ✔= The best test based on the feature </small>
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Revision as of 18:38, 30 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Diagnostic Study of Choice

Overview

Chest CT scan, preferably with intravenous contrast administration, may be helpful in the diagnosis of small cell carcinoma. Findings on CT scan suggestive of small cell carcinoma include hilar mass, mediastinal involvement, numerous lymphadenopathy, direct infiltration of adjacent structures, necrosis and hemorrhage. Small cell carcinoma of the lung is the most common cause of SVC obstruction, due to both compression/thrombosis and/or direct infiltration 2. All patients with confirmed diagnosis of SCLC by histopathological findings should undergo a CT scan of the abdomen for staging purposes. CT scan of the abdomen helps identify metastasis to organs, such as the liver or the adrenal glands. Brain imaging is also mandatory for staging; however, brain MRI is preferred over brain CT scan due to its superior sensitivity for the detection of brain metastasis. In addition, when limited stage small cell lung cancer is suspected, PET CT scan should be performed.

CT

Chest CT scan, preferably with intravenous contrast administration, may be helpful in the diagnosis of small cell carcinoma. Findings on CT scan suggestive of small cell carcinoma include:[1]

Microscopic Pathology

In small cell lung cancer, the tumor cells are small and round, but they can sometimes be ovoid or spindle shaped. They have a scant cytoplasm with a high mitotic count and a hyperchromatic nuclei. Nearly all small cell lung cancer are immunoreactive for keratin, thyroid transcription factor 1, and epithelial membrane antigen. Neuroendocrine and neural differentiation result in the expression of molecules like dopa decarboxylase, calcitonin, neuron-specific enolase, chromogranin A, CD56 (also known as nucleosomal histone kinase 1 or neural-cell adhesion molecule), gastrin-releasing peptide, and insulin-like growth factor 1. One or more markers of neuroendocrine differentiation can be found in approximately 75% of small cell lung cancer.[2]

Histopathologic image of small cell carcinoma of the lung. CT-guided core needle biopsy. H & E stain.By No machine-readable author provided. KGH assumed (based on copyright claims),via Wikimedia Commons [3]
Micrograph of a small-cell carcinoma of the lung showing cells with nuclear moulding, minimal amount of cytoplasm and stippled chromatin. FNA specimen. Field stain.By No machine-readable author provided. KGH assumed (based on copyright claims), via Wikimedia Commons [4]

References

  1. ↑ NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014
  2. ↑ National Cancer Institute: PDQ® Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional.
  3. ↑ href="http://www.gnu.org/copyleft/fdl.html">GFDL</a> or <a href="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0</a>], <a href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg">
  4. ↑ href="http://www.gnu.org/copyleft/fdl.html">GFDL ="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0], href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg">
  5. ↑ href="https://commons.wikimedia.org/wiki/File:Carcinoma_microcellulare_oatcell_carcinoma_or_anaplastic_carcinoma_(lung)H%26E_magn_200x.jpg

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